Xylazine-Related Wounds: Using Wound Care and Harm Reduction Best Practices to Improve Wound Healing and Patient Education for People Who Inject Drugs

BACKGROUND: Wound formation is a frequent complication among people who inject drugs (PWID), particularly when substances like fentanyl are adulterated with xylazine. Stigma, lack of resources, and socioeconomic factors contribute to ineffective wound care. Best practices in wound management, like the Debridement, Infection, Moisture control, periwound Edges (DIME) principles, demonstrate improved wound healing.

LOCAL PROBLEM: The project setting was a harm reduction exchange (HRE) in Tennessee. The project purpose was to implement a standardized wound care protocol and appropriate patient education regarding self-care of wounds. The project aims were to improve wound healing by 25% using evidence-based recommendations coupled with patient self-management education and to have 50% of PWID with skin wounds receive standardized wound care and education every two weeks for twelve weeks.

METHODS: The Johns Hopkins Evidence-Based Practice Model provided the project framework. A pre-implementation workflow was developed and adjusted during the project through Plan-Do-Study-Act cycles.

INTERVENTIONS: The Bates-Jensen Wound Assessment Tool (BWAT) and DIME principles were chosen for project use. Standardized homecare supply kits were distributed after each visit. The Self-Management Assessment Scale (SMASc) was used at each visit to measure patients’ self-management confidence.

RESULTS: The project had a 55% participation rate with a 53% return rate for follow-up care. Wound healing on the BWAT improved 33% for post-implementation. Positive percent changes from starting and ending mean scores for the five domains of the SMASc were 7.9%, 29.6%, 28.3%, 20.5%, and 10.7%.

CONCLUSIONS: Implementing a standardized wound care protocol for PWID with wounds had a clinically significant impact on wound healing. Using an assessment tool, providing self-care supply packets, and educating patients on self-management wound care had a positive impact for the patients and the HRE. The clinical staff at the HRE have affirmed the sustainability of this protocol and will continue to use it.